Disorders of Childhood

Disorders of Childhood Disorders of Childhood Undercontrolled (Externalizing) Problems for Others •Attention-Deficit/ Hyperactivity Disorder •Conduct Disorder More Prevalent in Boys Overcontrolled (Internalizing) Problems for Self •Childhood Depression •Anxiety Disorders More Prevalent in Girls Attention-Deficit/Hyperactivity Disorder  A disorder in children marked by difficulties in focusing adaptively on the task at hand, by inappropriate fidgeting and antisocial behavior, and by excessive non goal-directed behavior  Many have difficulties getting along with peers and establishing friendships  About 20-25 percent have a learning disability  Three subcategories: (1) children whose problems are primarily those of poor attention; (2) children whose difficulties result primarily from hyperactive-impulsive behavior; and (3) children who have both sets of problems. Etiology of ADHD  Genetic Factors - a predisposition is likely inherited  Environmental Toxins: – – – – Food Additives - unlikely Refined Sugar - unsupported Nicotine – likely Alcohol and drugs - likely  Psychodynamic - authoritarian parenting Treatment of ADHD  Stimulant drugs, in particular methylphenidate, or Ritalin, have been prescribed for ADHD since the early 1960’s. – 6% of schoolchildren and 25% of special education students use Ritalin – Improve concentration, goal-directed behavior, class behavior, and fine motor activity – Many not improve academic achievement – Significant side effects associated with use  Behavior therapy for ADHD also effective  Best approach - Stimulants + Behavior Therapy Conduct Disorder  Patterns of extreme disobedience in children, including theft, vandalism, lying,and early drug use.  Often behavior is marked by callousness, viciousness, and lack of remorse.  May be precursor of antisocial personality disorder  Oppositional defiant disorder - an undercontrolled disorder marked by high levels of disobedience to authority but lacking the extremes of CD Treatment of Conduct Disorder  Difficult to treat, as with APD  Juvenile incarceration leads to lower job stability and more adult crime  Gerald Patterson - Behavioral Parent Management Training - reduces the rate of criminal offense  Scott Henggeler - Multisystemic Therapy  Cognitive Skills Training  Moral Reasoning Skills Autistic Disorder  Presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests  Autism and Mental Retardation - approximately 80% of autistic children score below 70 on IQ tests  Autistic Savant - a mentally retarded person with superior functioning in one narrow area of intellectual activity  Extreme Autistic Aloneness - In autistic children early attachment is virtually absent Autistic Disorder  Communication Deficits - language delay, echolalia, pronoun reversal, neologisms, literal use of words  Obsessive-compulsive and Ritualistic Acts autistic children become extremely upset over changes in their daily activities and surroundings. They may have OC behaviors (lining up toys in a specific way) and are given to stereotypical behavior (e.g., hand movements, rocking)  Prognosis in Autistic Disorder - only 5 to 17% of autistic children have good adjustment in adulthood Etiology of Autistic Disorder  Psychological Basis - Bettelheim - autistic disorder caused by cold and rejecting parents. No support.  Biological Bases – Genetic Factors - the risk of autism in the siblings of people with autism is about 75 times greater than if the index case does not have the disorder – Neurological Factors - EEG and MRI studies have found abnormalities in autistic children Mental Retardation  Intelligence test scores below 75; 3 - 5% of the population  Deficits in adaptive functioning (e.g., toileting and dressing, use public transportation)  Time of onset before age 18 years (to rule out traumatic injury or illnesses occurring in later life) Vineland Adaptive Behavior Scales Age, Years 2 Adaptive Ability Says at least fifty recognizable words. Removes front-opening coat, sweater, or shirt without assistance. Tells popular story, fairy tale, lengthy joke, or plot of a TV program. Ties shoelaces into a bow without assistance. Keeps secrets or confidences for more than one day. Uses the telephone for all kinds of calls without assistance. Watches TV or listens to radio for information about a particular area of interest. Looks after own health. Responds to hints or indirect cues in conversation. 5 8 11 16 Classification of MR  Mild Mental Retardation (50-55 to 70-75 IQ) – Able to maintain themselves in unskilled jobs – May need help with social or financial problems  Moderate Mental Retardation (35-40 to 50-55 IQ) – Brain damage and other pathologies are frequent – Most live dependently within family or group homes  Severe Mental Retardation (20-25 to 35-40 IQ) – Commonly have congenital physical abnormalities – May be able to perform very simple work under supervision  Profound Mental Retardation (below 20-25 IQ) – Severe physical deformities and neurological damage – Very high mortality rate during childhood Deficiencies in Community use Functional academic skills Deficiencies in Health and safety Attention to stimuli Known Etiology Control function of language Home living skills Social skills Short-term memory Unknown Etiology Executive functioning Processing speed Selfdirection Self-care skills Work skills Communication Etiology of Mental Retardation  Genetic or Chromosomal Anomalies – Down Syndrome or Trisomy 21 – Fragile X Syndrome  Recessive-Gene Diseases – Phenylketonuria (PKU)  Infectious Diseases – Cytomegalovirus, toxoplasmosis, rubella, herpes simplex, and syphilis – HIV Down’s Syndrome Child Child with Fragile X Syndrome Learning Disabilities  Learning Disorders – Reading Disorder – Mathematics Disorder – Disorder of Written Expression  Communication Disorders – Expressive Language Disorder – Phonological Disorder – Stuttering  Motor Skills Disorder Etiology of Learning Disorders  Biological - – Family and twin studies confirm that there is a heritable component to dyslexia. – Autopsy studies have shown microscopic abnormalities in the location, number, and organization of neurons on the left side of the brain – PET scans reveal that the temporoparietal cortex of dyslexic children was not activated during cognitive tasks  Psychological – Visual perceptual deficits - perceiving letters in reverse order or mirror image – Language processing - dyslexics have been found to process visual stimuli more slowly than do normal people and to be less likely to notice minor contrasts between stimuli